概述

What is ulcerative colitis? A Mayo Clinic expert explains

Listen to gastroenterologist William Faubion, M.D., walk through ulcerative colitis basics.

I'm Dr. Bill Faubion, a gastroenterologist at Mayo Clinic. In this video, we'll cover the basics of ulcerative colitis. What is it? Who gets it? The symptoms, diagnosis, and treatment. Whether you're looking for answers for yourself or someone you love, we're here to give you the best information available. Ulcerative colitis is an inflammatory bowel disease that causes chronic inflammation and ulcers in the superficial lining of the large intestine, also called the colon. And that includes the rectum. It's estimated that about a million Americans are living with ulcerative colitis, making it the most common form of inflammatory bowel disease. It can be painful and debilitating, occasionally leading to severe complications. It can also be emotionally stressful. And while there is no cure, once you've been diagnosed, treatment can help you get back to a much more normal and comfortable life.

The exact cause of ulcerative colitis is unknown, but there are things that appear to trigger or aggravate it. It may involve an abnormal immune response against some microorganism in which your tissues are also attacked. Genetics might also play a role. You are at higher risk if a first-degree relative has it. There's also a correlation with age. Although it can show up at any stage of life, most people are diagnosed before the age of 30. And ethnicity is a risk factor. Whites have the highest risk, especially among people of Ashkenazi Jewish descent. While diet and stress don't cause ulcerative colitis, they are known to exacerbate symptoms.

Most people have mild to moderate cases of ulcerative colitis. Although it can be more severe, you may also experience periods of remission when you have no issues at all. A person's symptoms depend on the severity of the case in the area of the colon that's involved. They usually develop over time, and they can include diarrhea, often with blood or pus, fever, fatigue, anemia, loss of appetite and weight loss, abdominal pain and cramping, rectal pain and bleeding, the need for a bowel movement, yet the inability to do so despite the urgency. And in children, delayed growth and development. Over time, ulcerative colitis can lead to other complications, such as severe dehydration, a perforated colon, bone loss, inflammation of your skin, joints and eyes. It can also increase your risk for blood clots and colon cancer. These symptoms don't automatically mean that you have ulcerative colitis. But if you're experiencing anything that concerns you, it's a good idea to make an appointment with your doctor.

The only way to definitively diagnose ulcerative colitis is with a biopsy after taking a tissue sample through an endoscopic procedure. But first, less invasive things can be done to rule out other causes. First, your doctor will consider your medical history. They may want to run a variety of tests or procedures. And at some point, your general practitioner may refer you to a specialist called a gastroenterologist like myself. A blood test can check for anemia and check for signs of infection. A stool study can test for white blood cells and other specific proteins that point to ulcerative colitis, as well as rule out certain pathogens. A colonoscopy may be needed. This allows your doctor to view the entirety of the large intestine using an endoscope, a small camera mounted on a thin flexible tube. They can take tissue samples for a biopsy at the same time. Or if your colon is extremely inflamed, they may do a flexible sigmoidoscopy, which only goes as far as the rectum and lower or sigmoid colon. If your symptoms are more severe, your doctor may want some imaging done. An abdominal x-ray can rule out serious complications, like a perforated colon. An MRI or CT scan can also be performed for a more detailed view of the bowel, as well as to reveal the extent of the inflammation.

Although there is no cure for ulcerative colitis there are widely effective treatments, usually involving either drug therapy or surgery. Your doctor can work with you to find things that alleviate your symptoms and in some cases, even bring about long-term remission. Treatments may include anti-inflammatory drugs like corticosteroids and immune system suppressants. Certain targeted therapies directed against the immune system called biologics can help. Antidiarrheals, pain relievers, antispasmodics and iron supplements can help counter other symptoms. And surgery may be required to remove the damaged tissue. In extreme cases, the whole colon may be removed. Which sounds drastic, but this can sometimes be the best option for eliminating the pain and struggle of ulcerative colitis once and for all. Some of these therapies may have side effects themselves. So be sure to review the risks and benefits with your doctor.

Ulcerative colitis can be physically and emotionally challenging, but there are things that can help. Although there's no firm evidence that any foods cause ulcerative colitis, certain things seem to aggravate flare-ups. So a food diary can help you identify personal triggers. Beyond that, limit dairy products, eat small meals, stay hydrated, try to avoid caffeine and alcohol and carbonation. If you're concerned about weight loss or if your diet has become too limited, talk to a registered dietitian. It's important to take care of your mental health, too. Find ways to manage stress, like exercise, breathing and relaxation techniques or biofeedback. Some symptoms like abdominal pain, gas, and diarrhea can cause anxiety and frustration. That can make it difficult to be out in public for any amount of time. It can feel limiting and isolating and lead to depression. So learn as much as you can about ulcerative colitis. Staying informed can help a lot in feeling like you're in control of your condition. Talk to a therapist, especially one familiar with inflammatory bowel disease. Your doctor should be able to give you some recommendations. And you might want to find a support group for people going through the same thing that you are. Ulcerative colitis is a complex disease, but having expert medical care and developing a treatment strategy can make it more manageable and even help patients get back to the freedom of a normal life. Meanwhile, significant advances continue to be made in understanding and treating the disease and getting us closer to curing it or preventing it entirely. If you'd like to learn even more about ulcerative colitis, watch our other related videos or visit mayoclinic.org. We wish you well.

胃肠病科和胃肠道外科博客

在“妙佑医疗国际网联社区”中与他人交流,关注克罗恩病和溃疡性结肠炎治疗的最新进展。

溃疡性结肠炎是一种炎性肠病 (IBD),可引起您的消化道发炎和溃疡(疮)。溃疡性结肠炎会影响大肠(结肠)和直肠的最内膜。症状通常是逐渐恶化,而不是突发。

溃疡性结肠炎会导致患者衰弱,有时会导致危及生命的并发症。尽管尚无治愈方法,但治疗可以大大减轻疾病的体征和症状并可以长期缓解。

症状

发炎的严重程度和位置不同,溃疡性结肠炎的症状不同。体征和症状可能包括:

  • 腹泻,通常带血或脓液
  • 腹痛和痉挛
  • 直肠疼痛
  • 直肠出血 — 排便带少量血
  • 排便冲动
  • 有排便冲动但难以排出
  • 体重减轻
  • 疲劳
  • 发热
  • 儿童会无法发育

多数溃疡性结肠炎患者具有轻度到中度症状。溃疡性结肠炎的病程因人而异,有些人有很长的缓解期。

类型

医生经常根据溃疡性结肠炎的位置对其进行分类。溃疡性结肠炎的类型包括:

  • 溃疡性直肠炎。发炎仅限于最靠近肛门的区域(直肠),这种疾病的唯一症状可能是直肠出血。
  • 直肠乙状结肠炎。发炎涉及直肠和乙状结肠(结肠的下端)。体征和症状包括血性腹泻、腹部痉挛和疼痛,以及有大便欲但无法排便(里急后重)。
  • 左侧结肠炎。发炎从直肠一直延伸到乙状结肠和降结肠。体征和症状包括血性腹泻、腹部痉挛和左侧疼痛以及急迫便意。
  • 胰腺炎。这种类型通常会影响整个结肠,并可能导致严重的血性腹泻、腹部痉挛和疼痛、疲劳以及体重减轻。

何时就诊

如果您的排便习惯持续发生变化或出现如下体征和症状,请就诊:

  • 腹痛
  • 便血
  • 非处方药对其无效的持续性腹泻
  • 会将您从睡梦中唤醒的腹泻
  • 持续一两天以上的不明原因发热

尽管溃疡性结肠炎通常不会致命,但它是一种严重的疾病,在某些情况下可能会导致危及生命的并发症。

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病因

溃疡性结肠炎的确切病因仍然不清楚。以前怀疑是饮食和压力,但现在医生知道这些因素可能会加重但不会引起溃疡性结肠炎。

可能的原因是免疫系统故障。当您的免疫系统尝试抵抗入侵的病毒或细菌时,异常的免疫反应会导致免疫系统也攻击消化道中的细胞。

遗传似乎也有一定作用,因为溃疡性结肠炎在拥有患病家庭成员的人群中更为普遍。但是,大多数溃疡性结肠炎患者没有这种家族史。

风险因素

溃疡性结肠炎影响的男女人数大致相同。风险因素可能包括:

  • 年龄。溃疡性结肠炎通常在 30 岁之前开始。但是,它可以发生在任何年龄,有些人可能直至 60 岁以后才会出现这种疾病。
  • 种族或族裔。虽然白人罹患这种疾病的风险最高,但是它会发生在任何人种中。如果您是阿什肯纳兹犹太人后裔,则风险更高。
  • 家族史。如果您有近亲(比如父母、兄弟姐妹或孩子)患有这种疾病,则您患病的风险更高。

并发症

溃疡性结肠炎可能的并发症包括:

  • 严重出血
  • 结肠孔(结肠穿孔)
  • 重度脱水
  • 骨量丢失(骨质疏松症)
  • 皮肤、关节和眼睛发炎
  • 结肠癌的风险增加
  • 快速肿胀的结肠(中毒性巨结肠)
  • 静脉和动脉血栓风险增加

在 Mayo Clinic 治疗

Feb. 23, 2021
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